Although both Black and White women and men suffer from eating disorders, there are important differences in the prevalence and form of the disorders. Eating disorders include anorexia nervosa (anorexia), bulimia nervosa (bulimia), and binge eating disorder. Anorexia nervosa and bulimia nervosa are both firmly entrenched in the DSM-IV — the psychiatrist's bible of mental disorders; whereas binge eating disorder is only listed in the appendix of the DSM-IV, although it is being considered for inclusion in the DSM-5.

Although all three of these disorders involve eating, there are some important differences between them. Both anorexia and bulimia are fueled by an obsessive desire for thinness, which results in dangerous behaviors, such as repeated vomiting and/or self-starvation, to reach the person's subjective ideal. People who engage in binge eating may or may not be excessively concerned with their appearance. And although binge eating disorder is a risk factor for obesity, not all binge eaters are obese and not all obese people binge on food. People with binge eating disorder may overeat when they feel distressed; they often feel powerless to stop eating, which is why binge eating disorder is also called compulsive overeating.

Eating disorders understudied in African Americans

Little was known about disordered eating in Black people until recently. Clinically, African Americans were under represented in treatment centers and research studies about eating disorders, so it wasn't clear if they were immune from such disorders or if social and cultural factors were imposing a barrier to treatment.

The National Survey of American Life (NSAL) conducted a comprehensive nationwide study of African American and Caribbean Blacks to answer these and other important mental health questions plaguing the Black community. They interviewed a large number of adults (n = 5,191) and adolescents (n = 1,170) in their homes, using professionally trained, ethnically-matched interviewers. Their study was the first to examine the prevalence, age of onset, and gender differences in eating disorders in a nationally representative Black sample (Taylor et al., 2007).

Black-White differences uncovered

The findings matched up with previous research showing that anorexia is rare among African Americans. In fact, not a single woman in the study met criteria for anorexia in the previous 12 months, and there were no reports at all of anorexia in Caribbean adults. Interestingly, however, the age of onset for anorexia was lower for African American adults (14.9 years) compared with late adolescence as seen in a prior similar national study with primarily White participants (18.9 years), and there were no cases among African Americans occurring after age 19. These findings indicate that Black Americans are at lower risk of anorexia than their White counterparts, and Caribbean Blacks are at an even lower risk. Although when African Americans do have anorexia, the age of onset is lower and the course of the disorder is longer. The lower rates of anorexia are thought to be due to less of an emphasis on thinness in African American culture operating as a protective factor.

Lifetime prevalence rates found for bulimia in Black Americans is 1.5% for adults, which is slightly higher than the national average of 1.0%. The average age of onset is 19 years, which is the same as the general population. Thus, rates of bulimia among Blacks may not be as uncommon as once believed. This finding could be an indication that Black people do feel pressure to conform to the American ideal of thinness, contributing to the higher rate of bulimia, although not to the more extreme level that is connected to the development of anorexia.

Binge eating is not uncommon in African Americans.

Binge eating was the most prevalent eating disorder among Blacks in the NSAL, with a lifetime prevalence of 1.7%, although 5.1% had some problems with binge eating whether or not they met criteria for a disorder. Males were significantly less likely to binge than women, but may have more issues around behaviors that emphasize an athletic build. While most eating disorders had an age of onset during adolescence, binge eating had the highest age of onset (22.8), which is similar to the general population. This older age of onset may reflect less of a concern for smaller body size and may represent more of a reaction to stress. Lower incomes and stress due to racism may have an effect on the drive to binge as a coping mechanism.

As in previous research, adult women had higher prevalence of eating disorders than men in the NSAL study. There were no gender difference in eating disorders among teens, but there was a tendency for boys to exhibit more disordered eating behaviors during adolescence. There is some research that indicates this could be due to weight restrictions for sports participation, such as school football, boxing, wrestling teams, etc. Therefore, Black boys should not be considered immune to eating disorders.

Taken as a whole, research shows that cultural differences must be taken into account when considering eating disorders in African Americans. Clinicians should be prepared to recognize and treat groups that may be least likely to develop an eating disorder. This will require training to work with diverse cultural groups to ensure that appropriate treatment is provided. Professionals should be educated to possible differences ing prevalence, age of onset, persistence and gender differences in eating disorders, including differences among subgroups of Black people. The social climate and subculture in which a person was raised may effect the risk and course of development of an eating disorder. Earlier and more frequent screening of eating disorders in Black communities may be a critical component to capturing cases of these disorders.

Thank you so much for writing and posting this article. So little attention is paid to African American women. Great information. Ilissa Banhazl, Marriage and Family Therapy in Glendora www.eatingdisordersgroup.com

Hi black american here, I would personally like to say that the research done on this study is of the poorest possible quality. I am questioning a few things the first of which is the sample size of this anorexia survey the second is was this survey taken on one select population you can not for instance go to a big city like Houston Texas and expect their results to speak for all black Americans in the United States. Everything about this article seems very off except for possibly the tendency to binge eat which is part cultural stereotype part truth.

I agree that the research done on this study is poor. That's why I feel that this article was incredibly irresponsible to write. I agree that the tendency to binge eat is partly a cultural stereotype. I've been diagnosed with purging anorexia, and I know of so many other women of colour who exibit anorexic and bulimic behaviours, who for whatever reason have no sought care or had the insurance reasources to seek help.

I hate this article with a passion. It's misinformation like this that spreads stereotype. Who actually believes this tripe.

Thinness is very much an issue among blacks. A lot of women will say that they like to be 'thick' or that they like 'curves', but I'm complimented by every black woman I run across by being barely 100 pounds at 5'5".

This article is such BS and an embarrassment. These stereotypes are a big part of the reason that my treatment practitioners for a long time misdiagnosed me, because they bought into the stereotype that black women have no desire to be thin, and the 'angry black woman' stereotype. I'm so sorry I attempted those treatments which failed, and 13 years later, I find myself still stuck in the starve/purge cycle (they were convinced that I binged for years and years, when really I restricted and purged.) Ugh. Such BS.

Okay, I checked it out. The study may be low in participants, 5,000 something (respectable), but we must credit it for being the first of it's kind. We have to start small sometimes. She does quote national statistics. I do not disagree with the comments the author made concerning the relationship between eating disorders and the different cultural populations. This is compatible with my knowledge. I find the age of onset to be a bit out of date as we are finding girls and boys in kindergarten dealing with eating issues. The teen population is exploding with eating disorders as well. However, we must thank the author for bringing attention to the need for clinicians to train and learn about diversity and eating disorders. Again, we start small but slowly the audience grows and before you know it there's change.- " A positive reframe"

Thank you for bringing much needed attention to Blacks who have eating disorders. I am Black , 48 and was recently hospitalized and diagnosed with anorexia, binge/purge subtype. I was “pleasantly” surprised that out of the seven folks on the EDU, three others were Black, one, a young boy.
Though I’ve had an ED for 29 years, I am just now realizing I have a problem.
Thank you again for publishing this article.